Assefa was on track to break the record and accelerated in the final 10 kilometres, but faded in the closing stages, visibly limping across the finish line before collapsing on the road.
The Ethiopian missed the podium ceremony as she was receiving medical treatment at the time the honours were handed out.
She finished in a time of 2hr 11min 04min, the third best in history and breaking her personal best and course record of 2:11:53, set in 2023.
Assefa's late fade means the women's world record of 2:09:56 remains in the possession of Ruth Chepngetich, a mark clouded by the Kenyan's three-year doping ban handed down in 2025.
It was an all-Ethiopian podium as Bedatu Hirpa finished second in 2:16:53 and Dera Dida came third in 2:16:55.
Ethiopia's Guye Adola won the men's race in 2:02:50, adding another Berlin crown after his 2021 victory in the German capital.
Adola's time was off world record pace and outside the course record of 2:01:09, set in 2022 by five-time Berlin winner Eliud Kipchoge.
The 35-year-old did not take the lead in the race until the 30-kilometre mark but was able to emerge with a lead of almost 30 seconds when he crossed the finish line.
"My goal was to hold back a bit and see what the pacemakers did so I could know exactly what was happening — and that worked wonderfully well," Adola said to Germany's RTL.
"I love Berlin, totally.
I love being back here and there's a pretty good chance I'll be back again." Gemechu Dida took second in 2:03:19, continuing an impressive event for the Ethiopians, with Gabriel Geay of Tanzania third in 2:03:59.
World record past Held in temperate September, the Berlin marathon is considered the fastest of the major courses.
The world record has been broken 13 times in Berlin, more than anywhere else.

Pakistan · World · Independent Digital Newsroom
